Beyond recycling: an LCA-based decision-support tool to accelerate Scotland's transition to a circular economy

Resources and waste strategies have recently seen a shift in focus from weight-based recycling targets to impact-driven policies. To support this transition, numerous decision-support tools were developed to help identify waste streams with the highest impacts. However, the majority of these tools focus solely on greenhouse gas emissions and show a narrow picture of the overall environmental impacts. Furthermore, they cover burdens associated with direct waste management activities and hence fall short when it comes to highlighting the substantial benefits that can be achieved by preventing waste in the first place. This paper quantitatively demonstrates the necessity to adopt impact-based targets that go beyond estimating the greenhouse gas emissions of waste and highlights the substantial benefits of waste reduction and prevention. Using a state-of-the-art waste environmental footprint tool, the paper quantifies the overall environmental impacts of Scotland's household waste and shows how targeting ‘heavy’ materials does not necessarily have the highest overall environmental benefit. Results show that embodied environmental impacts of household waste dominate the total environmental burdens, contributing more than 90% to the whole life cycle impacts, and hence policymakers should prioritise interventions that aim at waste reduction and prevention. Moreover, our analysis shows that food and textile wastes are high-priority materials in Scotland, with the largest contribution to overall environmental burdens; up to 42% and 30%, respectively. Considering the overall environmental impacts of specific waste materials will enable policymakers to develop more granular and targeted interventions to accelerate our transition to a sustainable circular economy

Assessing Reliability of Myocardial Blood Flow After Motion Correction With Dynamic PET Using a Bayesian Framework

The estimation of myocardial blood flow (MBF) in dynamic PET can be biased by many different processes. A major source of error, particularly in clinical applications, is patient motion. Patient motion, or gross motion, creates displacements between different PET frames as well as between the PET frames and the CT-derived attenuation map, leading to errors in MBF calculation from voxel time series. Motion correction techniques are challenging to evaluate quantitatively and the impact on MBF reliability is not fully understood. Most metrics, such as signal-to-noise ratio (SNR), are characteristic of static images, and are not specific to motion correction in dynamic data. This study presents a new approach of estimating motion correction quality in dynamic cardiac PET imaging. It relies on calculating a MBF surrogate, K 1 , along with the uncertainty on the parameter. This technique exploits a Bayesian framework, representing the kinetic parameters as a probability distribution, from which the uncertainty measures can be extracted. If the uncertainty extracted is high, the parameter studied is considered to have high variability - or low confidence - and vice versa. The robustness of the framework is evaluated on simulated time activity curves to ensure that the uncertainties are consistently estimated at the multiple levels of noise. Our framework is applied on 40 patient datasets, divided in 4 motion magnitude categories. Experienced observers manually realigned clinical datasets with 3D translations to correct for motion. K 1 uncertainties were compared before and after correction. A reduction of uncertainty after motion correction of up to 60% demonstrates the benefit of motion correction in dynamic PET and as well as provides evidence of the usefulness of the new method presented

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A pragmatic and industry-oriented framework for data quality assessment of environmental footprint tools

Environmental footprinting, underpinned by systematic life-cycle thinking, is increasingly seen as a critical concept for designing policies to fight climate change. The holistic nature of a life-cycle approach, built using the principles of Life Cycle Assessment (LCA), enables policy makers to understand the potential impacts and benefits of policy options. Although LCA is a widely used and well-established method, methodological aspects such as the quality of background data, model uncertainty, and comparison against existing literature are not usually communicated effectively to wider audiences, in particular policy makers. This paper introduces a novel hybrid data quality assessment method in the context of a case study based on the Scottish Waste Environmental Footprint Tool, a newly developed environmental life-cycle thinking tool. It offers an accessible method to present results of the data quality assessment of environmental models to policy makers and helps identify areas of improvements in future upgrades

Autologous endometrial cell co-culture improves human embryo development to high-quality blastocysts: a randomized controlled trial

International audienceDoes autologous endometrial cell co-culture (AECC) improve the number of good-quality blastocysts obtained by IVF/intracytoplasmic sperm injection (ICSI), compared with conventional embryo culture medium in a broad group of patients referred to assisted reproductive technology (ART)?Design: This interventional, randomized, double-blind study took place at Clinique Ovo from March 2013 to October 2015 and included 207 healthy patients undergoing an IVF or ICSI protocol, of which 71 were excluded before randomization. On the previous cycle, all participants underwent an endometrial biopsy at D5 to D7 post-ovulation, following which the endometrial cells were prepared for AECC.Results: The data demonstrated that AECC significantly increased the incidence of good-quality blastocysts compared with culture in conventional media (42.6% vs 28.4%, P < 0.001). No significant differences were found in pregnancy and live birth rates.Conclusion: This study demonstrated the benefits of AECC on blastocyst quality compared with conventional embryo culture medium, in a broader category of patients referred to ART as opposed to other studies that concentrated on specific causes of infertility only. However, limitations of the study design should be taken into consideration; the analysis was performed using embryos rather than patients and a follow-up of children born following the treatments could not be conducte